Hello everyone! I have a mental health provider (LCSW in an office setting in the Chicago suburbs) who insists Medicare changed the rules and will now allow her to bill telemedicine because her friends in NYC are billing and getting paid. Does the rural area rule no longer apply? How about BC/BS? Any help you can give would be much appreciated. Thanks!
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Wiki Telemedicine - mental health
- Thread starter beckycmbs
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- telehealth telemedicine
mitchellde
True Blue
Is it possible they are talking about the new codes created that do not need to follow the strict telemedicine rules? I copied for you below.
Keep in mind this is NOT the same as telemedicine. To bill telemedicine for office visits and mental health counseling you still must follow the telemedicine rules regarding geographic location of both provider and patient.
Review New Medicare Telemedicine CPT© Codes for 2019
The Social Security Act statute limits the use of telehealth to geographical locations, healthcare services, healthcare providers, and communication technology. The limitations concern services such as office visits, professional consultations, and office psychiatry services. All those services are billed as regular in-person meetings between healthcare providers and patients.
However, the limitations don’t concern services that are provided remotely with the help of various kinds of remote communication technology. They are not considered “Medicare telehealth services.”
Therefore, CMS updated the telehealth policy for Medicare by adding new telehealth CPT© codes and HCPCS codes regarding telemedicine reimbursement. The new telemedicine CPT codes and HCPCS codes address telemedicine reimbursement for:
Keep in mind this is NOT the same as telemedicine. To bill telemedicine for office visits and mental health counseling you still must follow the telemedicine rules regarding geographic location of both provider and patient.
Review New Medicare Telemedicine CPT© Codes for 2019
The Social Security Act statute limits the use of telehealth to geographical locations, healthcare services, healthcare providers, and communication technology. The limitations concern services such as office visits, professional consultations, and office psychiatry services. All those services are billed as regular in-person meetings between healthcare providers and patients.
However, the limitations don’t concern services that are provided remotely with the help of various kinds of remote communication technology. They are not considered “Medicare telehealth services.”
Therefore, CMS updated the telehealth policy for Medicare by adding new telehealth CPT© codes and HCPCS codes regarding telemedicine reimbursement. The new telemedicine CPT codes and HCPCS codes address telemedicine reimbursement for:
- Brief Communication Technology-Based Service, or Virtual Check-Ins (HCPCS code G2012) FQHCs (Federally Qualified Health Centers) and RHCs (Rural Health Centers) are now able to get reimbursed for brief interactions with patients over the phone or live video when assessing whether the patients should come in for an office visit. This improves convenience and efficiency for both healthcare providers and patients.
- Remote Evaluation of Pre-Recorded Patient Information (HCPCS code G2010) FQHCs and RHCs can now also get telemedicine reimbursement for remote patient evaluations when patients initiate consultations by sending pre-recorded videos or images containing patient information.
- Interprofessional Internet Consultation (CPT codes 99452, 99451, 99446, 99447, 99448, and 99449) The codes can cover consultations between professionals conducted via the internet or a phone call, and both professionals will be reimbursed. However, interprofessional internet consultation services are limited to healthcare practitioners who can independently get reimbursements from Medicare for evaluation and management visits. These telehealth billing codes don’t apply to FQHCs and RHCs.
Thanks, Debra. Since this provider isn't a FQHC or a RHC, she is only able to be reimbursed for the Interprofessional Internet Consults. I don't think this is what she was referring to so I will need to have her tell me specifics. I really appreciate your response!!!
I have a more accurate description of what the LCSW is asking. She states she can bill Medicare and BC/BS for POS 02 and a 95 modifier appended to the psychotherapy codes listed in Appendix P. I cannot locate information from Medicare on this. Does anyone have a link?
mitchellde
True Blue
That is telehealth and you no longer use the 95 modifier just the 02 POS. However the rules for telehealth did not change. The geographic restrictions are still in play. here is a link to the MLN booklet for telehealth issued January 2019
you must be certain your patient meets the geographic restrictions and your provider as the distant site provider meets those requirements. And keep in mind the patient must be a qualifying origination site and not in their home
you must be certain your patient meets the geographic restrictions and your provider as the distant site provider meets those requirements. And keep in mind the patient must be a qualifying origination site and not in their home